Understanding preeclampsia, a pregnancy disorder

Obstetric researchers have made much progress in the last decade to increase the safety of pregnancy and childbirth. But preeclampsia — a potentially life-threatening disorder — has continued to be a stubborn foe that affects almost 300,000 women annually. May is Preeclampsia Awareness Month, and communities nationwide are sponsoring walks to raise funds and educate the public.

For more information on the Chicago-area event, which will be held Sunday, go to http://www.preeclampsia.org. To learn more about the disease, we turned to Dr. Judith Hibbard, a professor of obstetrics and gynecology at the University of Illinois at Chicago.

Q. What is preeclampsia?

A. It is a condition that only pregnant women can get, marked by hypertension and accompanied by a high level of protein in the urine. If it progresses, the woman develops seizures, and then it is called "eclampsia." The problem is that the placenta is producing factors that cause the disease.

A. Typically, preeclampsia is most often seen in women having their first baby, teens or older moms, and in African-American women. Women who are diabetic or are pregnant with multiples also account for an increasing incidence of preeclampsia. It affects between 5 and 7 percent of U.S. pregnancies, depending on the region of the country and access to care. All of these increase a woman's chances of developing preeclampsia during the second or third trimester.

Q. What are the symptoms?

A. The high blood pressure and protein in the urine are the tip-off, but there are often no symptoms, which is why it's important for women to get good prenatal care and keep their appointments.

Q. Any other red flags?

A. Severe headaches, or flulike heartburn, or swelling in the hands, face and feet ... but that isn't always helpful because all pregnant women have swelling. I'd also add rapid weight gain or abdominal pain. In its most severe form, women can have vision and lung problems, seizures and even death, and the baby can be small, preterm or even stillborn. In many cases, patients did not know they needed to seek emergency care.

Q. What happens?

A. Normally, chemical signals from the placenta and fetus stimulate dilation of maternal blood vessels, especially those supplying the placenta. By setting up a good blood supply, the developing fetus is assured of adequate nutrition and oxygen. But in preeclampsia, the maternal blood vessels constrict rather than dilate ... and when the blood flowing through the placenta diminishes, the baby cannot grow normally.

Q. Is there any cure?

A. The only cure is to deliver the baby. In mild cases, the delivery will be delayed as long as possible until close to term. But in a severe or emergency situation, a doctor may have no choice but to deliver the baby early, regardless of age. Magnesium treatment protects the mother from seizures, and medications are given to lower blood pressure.

Q. Are there any drugs or treatments on the horizon? Is there something women can do to be proactive?

A. Normal weight gain, healthy diet and good prenatal care can help, but there is really no way to prevent preeclampsia. There is new research into developing rapid lab tests that will predict which women will develop preeclampsia several weeks before any signs appear. Future research will target drugs to prevent the development of preeclampsia, but this will take many more years.

Q. How did you get interested in preeclampsia? Did you treat someone with it during your training … or have a family member with the disease?

A. Early in my training, I found this disease fascinating as well as a huge challenge in managing my patients. I had an excellent research mentor, Dr. Marshall Lindheimer, at the University of Chicago, where there is a long history of research into this disease. He taught me much about preeclampsia throughout my career.

Q. What is the one thing you'd want women to know, to make them aware, but not scared?

A. Preeclampsia can be treated and managed to prevent severe complications for both the mother and baby. But a pregnant woman needs to have early, good prenatal care, and she needs to seek care if she develops any of the danger signs of preeclampsia.

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